Fundoplication is a surgical procedure conducted to treat gastroesophageal reflux disease (GERD) symptoms resulting from a hiatal hernia and weakened lower esophageal sphincter. Individuals who have not responded positively to traditional drug treatment for their GERD symptoms are considered likely candidates for this procedure. As with any medical procedure, there are risks associated with fundoplication and these should be discussed with a qualified health care provider prior to pursuing this treatment option.
Individuals who experience severe heartburn, severe esophageal inflammation, or a narrowing of the esophagus as a result of GERD symptoms are generally candidates for fundoplication surgery. Those who have not experienced any easing of their GERD symptoms with the use of traditional medication may also opt for surgery. Individuals who have developed additional symptoms such as hoarseness, persistent cough, or asthma may undergo surgery despite its risks in order to alleviate their symptoms and discomfort.
Requiring the use of general anesthetic, the surgical procedure involves the repositioning and suturing of the upper portion of the stomach, known as the fundus, around the esophagus. The repositioning of the stomach allows for easier esophageal passage through the stomach and strengthens the valve connecting the two, called the lower esophageal sphincter, which is instrumental in preventing acid backup. The existing hiatal hernia is repaired during the procedure to alleviate the individual's acid reflux symptoms. During the procedure, the hernia is removed from the chest area and repositioned in the abdomen and sutured in place. In some cases, the opening of the diaphragm may be tightened to reduce the chances of hiatal hernia recurrence.
Fundoplication is generally conducted through incisions made in the abdomen. In cases where an individual is overweight, the procedure may be performed through the chest. Individuals who have conventional surgery, requiring a single large incision made with a scalpel, should expect extended hospitalization and prolonged recovery. When conducted laparoscopically, several small incisions are made in the abdomen and the procedure is performed with the aid of a laser. Advantages of the laparoscopic procedure include a reduced hospital stay, less post-operative discomfort, and a shorter recovery time.
The procedure is rarely conducted on individuals of advanced age who are in ill health or who are experiencing symptoms which may not benefit from surgery. Individuals with a weakened esophagus are also unlikely candidates for fundoplication since the procedure may only complicate their condition. In some cases, a partial procedure may be conducted in order to ease symptoms for individuals who are unable to undergo fundoplication surgery.
Risks associated with fundoplication include swallowing difficulty, infection, and excessive bleeding. Individuals whose surgery is conducted laparoscopically may experience a post-operative condition where the esophagus moves, resulting in the loss of valve support between the esophagus and stomach. Risks associated with the use of general anesthetic include heart attack, blood pressure fluctuation, stroke, and arrhythmia.